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Updates to the Drug Benefit List - Spring 2008

• Additions to the Drug Benefit List
  • Open Benefits
  • New Limited Use Benefits
  • Special Formulary for Chronic Renal Failure
• Not Added to Formulary
• Drug Discontinued by the Manufacturer
• Replacement DINs

Benefit Definitions

Open Benefits

Open benefits are the drugs listed in the NIHB Drug Benefit List (DBL) which do not have established criteria or prior approval requirements.

Limited Use Benefits

Limited use drugs are those that have been found to be effective in specific circumstances, or which have quantity and frequency limitations. For drugs in this category, specific criteria must be met to be eligible for coverage.

Not Added To Formulary

Drugs not added to formulary are those which are not listed in the NIHB DBL after review by the national Common Drug Review (CDR) process and/or the Federal Pharmacy and Therapeutics Committee (FP&T). These drugs will not be added to the NIHB drug list because published evidence does not support the clinical value or cost of the drug relative to existing therapies. Coverage may be considered in special circumstances upon receipt of a completed "Exception Drugs Request Form". These requests are reviewed on a case by case basis.

Exclusions

Certain drug therapies for particular conditions fall outside of the NIHB mandate and will not be provided as benefits under the NIHB Program (e.g., cosmetic and anti-obesity drugs). As well, certain drugs will be excluded from the NIHB Program as recommended by the CDR and the FP&T because published evidence does not support the clinical value, safety or cost of the drug relative to existing therapies, or there is insufficient clinical evidence to support coverage.

Note: The appeal process and the emergency supply policy will not apply to excluded drugs.

Additions to the Drug Benefits List

Open Benefits

Single-Source Drug Products

Multi-Source Drug Products

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New Limited Use Benefits

Multi-Source Drug Products

Prior approval required.

1. - For treatment of hyperprolactinemia in patients who have failed therapy with or are intolerant to bromocriptine.

Prior approval required.

1. - For patients who cannot tolerate other tetracyclines
2. - For patients with severe widespread acne who have failed on tetracycline.

Prior approval required.

For treatment of type 2 diabetic patients who are not adequately controlled by or are intolerant to metformin and sulfonylureas or for whom these products are contraindicated.

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Special Formulary for Chronic Renal Failure

The following drug will be added to the Special Formulary for Chronic Renal Failure Patients:

Not Added to Formulary

The following drug products will not be added to the NIHB Drug Benefit List:

Drugs Discontinued by the Manufacturer

Replacement DINs

First Nations, Inuit and Aboriginal Health Features

NIHB - Information for Recipients

NIHB - Information for Health Providers

NNADAP Treatment Centres

Nursing Employment Opportunities

Funded Health Programs and Services